Employment Application · testing of employees ona reasonable suspicion basis, and for safety-sensitive or high risk jobs, and performs random substance abuse testing in areas mandated

AGC and Gar Kenyon are affirmative action employers. It is our policy to provide equal employment opportunityand advancement to all employees and applicants regardless of race, color, gender, gender identity, age,national origin, religion, pregnancy, physical or mental disability, sexual orientation, marital status, ancestryveteran status or any other status or characteristic which cannot lawfully be considered as a basis foremployment related decisions.

Personal Data First Name Middle Initial Last Name

Present Address City State, Zip Code How Long?

Prior Address City State, Zip Code How Long?

Home Telephone Business Telephone Cell Telephone Are you over 18 Years of Age?

Yes No Please list any other names under which your employment or educational records, references and Are you able to furnish proof that you are

other information in the application may be recorded. legally authorized to work in the United States?

Yes No

Work Preferences Position(s) Applied For Full Time First Shift Desired

Part Time - List Days/Hours Second Shift Salary/Wage RateThird Shift (if available)

Summer Only No Preference How did you learn of this opening?

Walk In Community Organization Employee ReferralEmployment Agency Federal, State or Local Employment Service Other __________________

Have you filed an application with our firms before? Were you previously employed by a LOAR Group firm? Yes NoYes No If Yes, When? What did you do?

If Yes, when? Which Firm?Why did you leave?

Do you have any friends or relatives working at a LOAR Group Company .

You may be requested to work overtime as the Company determines necessary. If Yes, please list: Will you be able to work such overtime?

Yes No

Do you have a reliable means of transportation to travel to and from work Can you travel if the Company requires it? If hired, what date can which will allow you to arrive to work on time? you start work?

Yes No Yes No If No, how will you arrive to work on time?

Work Preferences Having reviewed the job description for the position(s) for which you have applied, can you perform all the essential functions and tasks listed, either with or without reasonable accommodation? Yes No

If No, what are the functions or tasks which you cannot perform, even with a reasonable accommodation? Please identify these functions/tasks.

Employment Application

Please Comp le te En t i re F o rm fo r Max imum Cons ide ra t ion

In previous jobs you've held with other employers, were there any job functions or tasks which you were not able to perform even with reasonable accommodation?

Yes No

If Yes, what were the functions or tasks which you were unable to perform, even with a reasonable accommodation? Please identify these functions/tasks.

Having reviewed and been advised of our regular work hours and attendance needs for the position(s) for which you have applied, can you meet those work hour requirements and attendance needs? Yes NoIf No, please indicate what hours you can work and what attendance needs you can meet.

In previous jobs you've held with other employers, were you able to meet the attendance needs/requirements of those jobs ? Yes No If No, please indicate additional information you have that may be helpful in considering your application:

Answer Only for Positions Requiring use of a Company Motor Vehicle Do you have a valid Drivers' License? Have you been cited for a traffic violation or have been found guilty of motor vehicle

Yes No violations, of any kind, within the past five (5) years? Yes No License No.: If yes, please explain (dates/details)

State Issued: Exp. Date

Education and TrainingName and Address of School Course of Study Did You Grade Point Type of Degree

or Major Graduate? Average or Diploma

High School

College

Graduate School

Business or Technical School

Continuing Education

Can you read and/or work from blueprints? Please list all factory and/or office equipment you can operate

Yes No

Describe briefly any special skills, job relating training, education, licenses, certificates, etc., which you believe would help you qualify for the position(s) you are seeking.

Employment HistoryAccount for all time over the last 10 years, including periods of unemployment.

Employer Name May we contact your present employer for a reference? Yes No

Address/City/State Telephone

Name of Supervisor Employed From (Mo./Yr.)

Job Title and Duties Employed To (Mo./Yr.)

Reason(s) for Leaving:

Employer Name Telephone

Address/City/State Employed From (Mo./Yr.)

Name of Supervisor Employed To (Mo./Yr.)

Job Title and Duties

Reason(s) for Leaving:

Employer Name Telephone

Address/City/State Employed From (Mo./Yr.)

Name of Supervisor Employed To (Mo./Yr.)

Job Title and Duties

Reason(s) for Leaving:

Employer Name Telephone

Address/City/State Employed From (Mo./Yr.)

Name of Supervisor Employed To (Mo./Yr.)

Job Title and Duties

Reason(s) for Leaving:

All Other Positions Held (use additional sheet, if necessary)Name of Company Position Held From To Reason(s) for Leaving

Please explain fully any gaps in your employment history:

Have you ever been terminated or asked to resign from any job? If yes, please explain circumstances.

Professional or Business ReferencesName Occupation Employer's Name & Address Telephone Number

1.

2.

3.

Statement of ApplicantThe fo l low ing sec t ion o f t h e app l i c a t ion mus t b e comp le ted and s igned, o r we w i l l n o t b e ab le to a ccep t and p rocess this application.

I hereby au thorize the company - o r, i f re fe rred by an employment agency, t ha t agency - t o invest iga te my background and to co l lect t he fo l low ing in f o rmat ion about me in connect ion w i th t h is app l i ca t ion fo r employment .

1 From any schoo l I have a t tended - in fo rmat ion regard ing da tes o f a t t endance, g rades, class rank, courses taken , andeva lua t ion o f my academic perfo rmance and conduct .

2 F rom any employer f o r whom I have worked - da tes o f employment , job du t ies, compensat ion , in fo rmat ion aboutmy work perfo rmance and work re la t ionsh ips, a t t endance, workp lace conduct , reason(s) f o r leaving andeligibil it y f or rehire.

3 Any in fo rmat ion o r report t ha t is re fe red to in t he au thoriza t ion fo r consent t o p rocure background and re fe rencecheck.

Please check i f you DO NOT w ish AGC or Gar Kenyon to con tact your p resent employer un t i l an o f fe r i s made.

I a l s o r e l eas e an d h o l d h ar m l es s f r o m an y an d a l l c l a i m s , l i ab i l i t y an d d am ag es a l l p er s o n s , c o m p an i es , c o r p o r a t i o n s , s c h o o l s , credit b u r eau s an d l aw en f o r c em en t ag en c i es f o r p r o v i d i n g s u c h i n f o r m at i o n .

I understand tha t t h is in fo rmat ion , t oge ther w i th any in fo rmat ion he ld by AGC or Gar Kenyon about me as a fo rmer employee or app l i can t , w i l l beused both to veri f y my qua l i f i ca t ions fo r t he job(s) f o r wh ich I have app l ied and , i f I am employed by the company, f o r job p lacement purposes. I further understand tha t any o f fe r o f employment i s sub ject t o AGC's and /o r Gar Kenyons rece ip t o f sa t i sfacto ry re fe rence report s. Th is au thoriza t ion expires one (1 ) year f rom the da te be low.

I c er t i f y t h a t a l l an s w er s an d i n f o r m at i o n I h av e g i v en i n t h i s ap p l i c a t i o n a r e t r u e , ac c u r a t e an d c o m p l e t e . I u n d er s t an d an d ag r ee t h at an y o m i s s i o n s , m i s s t a t em en t s o r m i s r ep r es en t a t i o n s i n t h i s ap p l i c a t i o n s h a l l b e c o n s i d er ed s u f f i c i en t c au s e f o r r e j ec t i o n o f t h i s application, w i t h d r aw a l o f an y , em p l o y m en t o f f e r m ad e o r d i s m i s s a l f r o m em p l o y m en t w i t h A GC o r Gar K en y o n .

I u n d er s t an d t h a t i f I am h i r ed b y A GC o r Gar K en y o n , t h e Co m p an y m ay , i n i t s d i s c r e t i o n , t e r m i n a t e m y em p l o y m en t an d c o m p en s at i o n at an y t i me, w i t h o r w i t h o u t n o t i c e , w i t h o r w i t h o u t c au s e , f o r an y o r n o r eas o n , an d I m ay d o t h e s am e. I f u r t h er u n d er s t an d t h a t t h i s application i s n o t an d i s n o t i n t en d ed t o b e a c o n t r ac t o r g u ar an t ee o f em p l o y m en t o r a p r o m i s e o f em p l o y m en t o r c o m p en s at i o n f o r a s p ec i f i c period o f t i m e. I f u r t h er u n d er s t an d an d ac k n o w l ed g e t h a t t h er e a r e n o ag r eem en t s o r u n d er s t an d i n g s , o r a l o r i n w r i t i n g , d i f f e r en t f r o m the f o r eg o i n g u n d er s t an d i n g . A n y m o d i f i c a t i o n s o f t h i s u n d er s t an d i n g m u s t b e i n w r i t i n g an d s i g n ed b y t h e Pr es i d en t o f t h e Co m p an y .

AGC and Gar Kenyon in t he course o f i t s business, perfo rms work as an FAA (Federa l Avia t ion Admin ist ra t ion) l i censed repa i r sta t ion . Al l applicants for employment w i th t he company who may be h i red to perfo rm work w i l l be requ i red , as part o f t he i r f i na l screen ing process, to submitto urine testing f o r evidence o f substance use /abuse o f amphetamines, coca ine , mari juana, op ia tes and phencycl id ine (PCP). Re fusa l t o submi t t o substance abuse testing o r f a i lu re to successfu l l y comple te a substance abuse test (i . e . , posi t i ve test resu l t ) w i l l resu l t i n t he app l i can t be ing no t med ica l l y cleared for and be ing re jected f rom employment . I n add i t ion to app l i can t substance abuse test ing , t he compay does substance abuse test ing o f employees on a reasonab le susp icion basis, and fo r sa fe t y-sensi t i ve o r h igh ri sk jobs, and perfo rms random substance abuse test ing in a reas mandated by the FAA.

I understand tha t any job o f fe r w i th AGC or Gar Kenyon i s cond i t iona l upon my ab i l i t y t o estab l i sh employment e l ig ib i l i t y under t he Immigra t ion Reform and Cont ro l Act o f 1986 and the sa t i sfacto ry comple t ion o f any app l i cab le med ica l assessment and /o r substance abuse test ing .

Applicant Signature: Date

AN EQUAL OPPORTUNITY EMPLOYER